{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:29:08Z","timestamp":1789684148429,"version":"4.0.1"},"reference-count":44,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust J Dermatology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Melasma is a chronic hyperpigmentation disorder that disproportionately affects women and individuals with darker skin types, leading to a significant psychosocial burden. This meta\u2010analysis aims to evaluate the safety and efficacy of the 755\u2010nm picosecond alexandrite laser (PSAL) compared with conventional therapies in the management of melasma. PubMed, Ovid Medline, Embase, Cochrane Library, and Google Scholar were searched from inception to April 10, 2025, in accordance with PRISMA guidelines. Randomised controlled trials (RCTs) assessing PSAL versus control comparators in adults with melasma and reporting Melasma Area and Severity Index (MASI) or Modified MASI outcomes were included. The review was registered prospectively on PROSPERO (CRD420251022381). Risk of bias was assessed using ROB2. Pooled effect sizes were calculated using a random\u2010effects model. Five RCTs (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009139 patients) were included. Change in MASI favoured triple combination cream (TCC) over PSAL therapy (MD\u2009=\u20091.82, 95% CI: 1.11, 2.52,\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%). Post\u2010inflammatory hyperpigmentation was more common in the PSAL group compared to topical creams (OR\u2009=\u20096.86, 95% CI: 1.47, 32.07,\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%) but had no difference with the\n                    <jats:italic>Q<\/jats:italic>\n                    \u2010switched lasers (OR\u2009=\u20094.09, 95% CI: 0.62, 26.97,\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%). There was no incidence of hypopigmentation or infection reported. PSAL appears inferior to the TCC in reducing MASI scores. Overall certainty is low due to small, heterogenous trials. Low rates of irreversible adverse events with PSAL may support trials in refractory cases, but long\u2010term RCTs with larger sample sizes are required to evaluate durability and recurrence outcomes.\n                  <\/jats:p>","DOI":"10.1111\/ajd.70051","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T07:54:52Z","timestamp":1769500492000},"page":"140-150","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Assessing the Safety and Efficacy of Picosecond Alexandrite Lasers in the Management of Melasma: A Systematic Review and Meta\u2010Analysis of Randomised Control Trials"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4095-4605","authenticated-orcid":false,"given":"Kangjie R.","family":"Chua","sequence":"first","affiliation":[{"name":"Royal Prince Alfred Hospital  Camperdown Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilip K.","family":"Vankayalapati","sequence":"additional","affiliation":[{"name":"John Radcliffe Hospital Oxford University Hospitals NHS Trust  Oxford UK"},{"name":"Wollongong Hospital  Wollongong Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Zaid","family":"Shami","sequence":"additional","affiliation":[{"name":"HCA Florida Aventura Hospital  Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Antoniou","sequence":"additional","affiliation":[{"name":"Department of Basic and Clinical Sciences University of Nicosia Medical School  Nicosia Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma J. B.","family":"Nordahl","sequence":"additional","affiliation":[{"name":"Department of Basic and Clinical Sciences University of Nicosia Medical School  Nicosia Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kowthar","family":"Abdul\u2010Aziz","sequence":"additional","affiliation":[{"name":"The University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laith","family":"Bayan","sequence":"additional","affiliation":[{"name":"The Queen Elizabeth Teaching Hospital King's Lynn NHS Foundation Trust  Norfolk UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sum\u2010Yu C.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Basic and Clinical Sciences University of Nicosia Medical School  Nicosia Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayato","family":"Nakanishi","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4193-9925","authenticated-orcid":false,"given":"Christian A.","family":"Than","sequence":"additional","affiliation":[{"name":"Cambridge University Hospitals NHS Foundation Trust Addenbrookes Hospital  Cambridge UK"},{"name":"School of Biomedical Sciences The University of Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5946-1786","authenticated-orcid":false,"given":"Davin","family":"Lim","sequence":"additional","affiliation":[{"name":"Cutis Clinic  Indooroopilly Australia"},{"name":"The Melasma Clinic  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/pcmr.12684"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0262833"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2023.07.1045"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/09546634.2024.2361106"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.31128\/AJGP\u201005\u201021\u20106002"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58070936"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.23382"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.16104"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103\u2010023\u201003744\u2010y"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103\u2010018\u20102529\u20102"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.22454"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2009.10.051"},{"key":"e_1_2_14_15_1","unstructured":"A.Rohatgi \u201cWebPlotDigitizer \u201dhttps:\/\/automeris.io."},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_14_17_1","volume-title":"Translational Radiation Oncology","author":"Eltorai A. 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